Spontaneous mesenteric hematoma complicating an exacerbation of Crohn’s disease: report of a case

BMC Surgery

Pawan Mathur²  Derek J Boyle²  Anuja Mitra²  James HR Manfield²  Hutan Ashrafian¹ 

[1] Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, Praed Street, London W2 1NY, UK;Department of General Surgery, Barnet Hospital, Barnet and Chase Farm Hospitals NHS Trust, Wellhouse Lane, Barnet EN5 3DJ, UK

关键词: Surgery;    Inflammatory bowel disease;    Mesenteric haematoma;    Crohn’s disease;   

Others  :  800166
DOI  :  10.1186/1471-2482-14-35

 received in 2013-07-17, accepted in 2014-05-27,  发布年份 2014

【 摘 要 】

Case Presentation

Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause. Here we report a case of spontaneous mesenteric haematoma during an inflammatory exacerbation of Crohn’s disease. The patient underwent surgical management for small bowel obstruction secondary to Crohn’s disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively.

Conclusion

This case identifies the first association of spontaneous mesenteric haematoma with an exacerbation of Crohn’s disease and highlights the need to consider rare differential diagnoses such as SMH when performing radiological assessment of unexplained symptoms in inflammatory bowel disease patients.

【 授权许可】

   
2014 Ashrafian et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Gardiner KR, Dasari BV: Operative management of small bowel Crohn’s disease. Surg Clin North Am 2007, 87(3):587-610.
• [2]Baumgart DC, Sandborn WJ: Crohn’s disease. Lancet 2012, 380(9853):1590-1605.
• [3]Thornton M, Solomon MJ: Crohn’s disease: in defense of a microvascular aetiology. Int J Color Dis 2002, 17(5):287-297.
• [4]Ha C, Magowan S, Accortt NA, Chen J, Stone CD: Risk of arterial thrombotic events in inflammatory bowel disease. Am J Gastroenterol 2009, 104(6):1445-1451.
• [5]Abbas MA, Collins JM, Olden KW: Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol 2002, 179(6):1389-1394.
• [6]Parker SG, Thompson JN: Spontaneous mesenteric haematoma; diagnosis and management. BMJ Case Rep 2012., 2012doi:10.1136/bcr-2012-006624. PMID: 22865811
• [7]Gomez D, Rahman SH, Guillou PJ: Spontaneous mesenteric haematoma: a diagnostic challenge (On-line case report). Ann R Coll Surg Engl 2006, 88:1-3.
• [8]Ashley S: Spontaneous mesenteric haematoma and small bowel infarction complicating oral anticoagulant therapy. J R Soc Med 1990, 83(2):116.
• [9]Cawyer JC, Stone CK: Abdominal apoplexy: a case report and review. Am J Emerg Med 2011, 40(3):e49-e52.
• [10]Whitcomb DC, Muddana V, Langmead CJ, Houghton FD Jr, Guenther A, Eagon PK, Mayerle J, Aghdassi AA, Weiss FU, Evans A, Lamb J, Clermont G, Lerch MM, Papachristou GI: Angiopoietin-2, a regulator of vascular permeability in inflammation, is associated with persistent organ failure in patients with acute pancreatitis from the United States and Germany. AmJ Gastroenterol 2010, 105(10):2287-2292.
• [11]Peyrin-Biroulet L, Gonzalez F, Dubuquoy L, Rousseaux C, Dubuquoy C, Decourcelle C, Saudemont A, Tachon M, Beclin E, Odou MF, Neut C, Colombel JF, Desreumaux P: Mesenteric fat as a source of C reactive protein and as a target for bacterial translocation in Crohn’s disease. Gut 2012, 61(1):78-85.
• [12]Siegmund B: Mesenteric fat in Crohn’s disease: the hot spot of inflammation? Gut 2012, 61(1):3-5.